Record numbers of people are attending A&E departments, official figures
have shown, as GP out of hours and immigration have driven huge increases in
visits over the last seven years.

In the last year 20.5 million people attended A&E Departments in England – the equivalent of 40 per cent of the population making one visit.

It is the first time attendances have topped 20 million and is an increase of almost five per cent in one year.

A combination of confusion over GP out of hours services and increases in immigrants who tend to visit A&E routinely and not register with family doctors is thought to be to blame.

Officials said that extra new walk-in centres and minor injuries units which were more convenient for patients and shorter waiting times in A&E, with 98 per cent seen within four hours, also meant people were more likely to attend.

A&E attendances were relatively stable throughout the 1980s and 1990s at around 14 million per year.

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But since 2002/3 attendances have risen sharply jumping from 14m to 16.5m in one year.

The new GP contract which allowed family doctors to opt out of being responsible for out of hours services came into force in April 2004, after the increases had already started but confusion over where patients should seek help has been blamed in surveys for rises in A&E visits.

Reducing A&E attendances and treating more people closer to their homes in primary care had been a key aim of the Labour government.

The Conservatives have pledged to stop all closures of A&E and maternity units which are not backed by local clinicians.

John Heyworth, president of the College of Emergency Medicine, said experience from doctors in A&E is that there has been a real rise in seriously ill and injured patients and not that people with minor ailments are wrongly going to hospital.

He said the 'myth' that 60 per cent of A&E attendances could be dealt with in primary care had been exposed by recent research.

Dr Heyworth said: "The rise is real and it needs to be recognised. We have an ageing population and more elderly are coming into the emergency departments.

"Also the GP contract changes has undoubtably been a significant contributor to the rise as out of hours care in many areas is fragmented, inconsistent and very patchy so patients come to the emergency department by default."

He added that in inner cities and particularly London, immigrants tended to visit A&E instead of GPs so family doctors should work at the emergency department in those areas and alcohol-related attendances are also continuing to rise.

Minor injuries units and walk-in centres had been a failure and data has shown these have not led to a drop in A&E attendances, he said.

Dr Heyworth added: "This has to stop now. They are expensive, wasteful and confusing for patients. That money could have transformed emergency care."

Dr Andrew Hobart, Chairman of the British Medical Association’s Emergency Medicine Subcommittee said: “The harsh weather over last winter combined with the outbreak of pandemic flu will have contributed to this sharp rise in attendance at emergency departments compared to the previous year.

“However, there is also a longer-term trend that shows an increase in emergency department attendances. This reflects the fragmentation of urgent and emergency healthcare as alternative types of service, such as NHS direct, walk in centres, urgent care centres and polyclinics have been introduced largely unsupported by any good evidence of clinical or cost effectiveness.

“The proliferation of these services has led to confusion among patients about where to access care but, as these figures show, there has been no reduction in the workload of Emergency Departments. Investment urgently needs to be redirected into integrated services based around traditional General Practices and fully functioning Emergency Departments.”

A spokesman for the Department of Health said: "It is not clear why A&E attendances are rising nationally. However, it is clear that there is faster growth in attendances at type three A&E departments which treat more minor illnesses and injuries than at type one (major) A&E departments where attendances grew by 1.4 per cent last year.

"Primary Care Trusts need to understand the pattern of demand in their local area so that they can commission services that reflect the needs of patients."